Well, others have given you reasonable thoughts...

My question, depends in part on clinical data, particularly the pathology report.

From my perspective, a PSA like that so soon after surgery may indicate high risk. Other data such as Gleason Score, Grade Group, Pathology report about ECE, Margins, SV, % of prostate involved, lymph nodes, Stage, PSA Doubling and Velocity times...would be useful.

It sounds like your urologist is saying SRT combined with ADT.

Hmm, my question, have you talked with a radiologist, what about an oncologist?

In high risk cases, there is some thought that radiation should include the whole pelvic lymph nodes, not just the prostate bed. Has that been discussed? Also, has adding an ARI been discussed?

Again, my thoughts, my experience, if your clinical data indicates high risk PCa, your urologist may be "aiming low...!" If you have not done so, bring a radiologist and oncologist into the discussion, discuss double or triplet therapy. Discuss whether or not chemotherapy is in play.

Here's one link to the discussion - https://dailynews.ascopubs.org/do/would-you-use-doublet-therapy-and-not-triplet-therapy-patient-newly-diagnosed-mhspc, you can find others.

As to the lengthy of ADT, depends on your clinical data and risk but generally 24 months of ADT + ARI

At the PSA you describe, a PSMA PET has statistically a 1/3 chance of locating activity, so, not unsurprising it has not shown where that activity is.

Given what you describe, you may have Advanced PCa. Is it "curable?" There is some discussion that in its early stages, yes, if you hit it hard and arc aggressive in your treatment choice. There is also some discussion that says no, you can manage it, I'm in the latter camp. In part, that depends on your clinical data and risk, low, intermediate,..

Don't mind me, just a layman like the rest of us!

Kevin